Declining free healthcare and rising treatment costs in India: an analysis of national sample surveys 1986-2004

The article focuses on trends in health-seeking behaviour of people and choosing between government and private sources, reasons for not accessing health care and the cost of treatment by examining three rounds of NSS data on health care use and morbidity pattern during 1986–87, 1995–96 and 2004. With variation across states, treatment-seeking from public providers has declined and preference for private providers has increased over the period. Although overall health-seeking behaviour has improved for both males and females, a significant percentage of people, more in rural than urban areas, do not seek treatment due to lack of accessibility and consider that the illness is not serious enough to require treatment. The financial reason for not seeking treatment was also an important issue in rural areas. There has also been change in the cost of health care over time. While the health care cost has increased, the gap between the public and the private has reduced, owing to perhaps increased cost of treatment in public health facilities following the levying of user-fees and curtailing distribution of free medicine. Practically all states reported decline in availability of free both out-patient and in-patient care. The article concludes with supporting the adaptation of innovative public-private partnership in health sector for various services realizing the limitations of the state provision of health, particularly in rural and remote areas, and the growing preference of consumers for private health providers. As effectiveness of public spending also depends on the choice of health interventions, target population and technical efficiency partnering with private health providers could work towards reducing the health inequalities in the country

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Not AvailableAim: This study was conducted to find out the relationship of prepartum udder and teat measurements with subsequent milk production traits in primiparous Nili-Ravi buffaloes. Materials and Methods: A total of 12 Nili-Ravi buffalo heifers were selected from Buffalo Farm, Central Institute for Research on Buffaloes, Regional Station- Bir Dosanjh, Nabha, Patiala, Punjab. The udder length (UL), udder width (UW), udder depth, teat length (TL), teat diameter (TD), and teat distances were measured at fortnightly interval from 60 days prepartum until calving. After calving, 60 days total milk yield (TDMY), peak yield (PY), and days taken to attain PY (DPY) were also recorded. The correlation coefficients of various prepartum udder and teat measurements since 60 days prepartum to calving with 60 days TDMY, PY, and DPY were calculated to find out the relationship between the traits in primiparous Nili-Ravi buffaloes. Results: The result envisaged that all udder and teat measurements were increased gradually toward the date of calving in primiparous buffaloes. The UL, UW, left fore (LF) and right rear (RR)TL, RRTD, and the distance between LF to left rear (LR) teat were positively correlated with 60 days TDMY. The UL and UW depicted positive but nonsignificant correlation with PY. Fore TLs showed positive correlation where as TDs and teat distances had a negative correlation with the DPY in primiparous Nili-Ravi buffaloes. Conclusion: It was concluded that milk production performance could be assessed on the basis of prepartum udder and teat measurements in primiparous Nili-Ravi buffaloes.Not Availabl

Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana

Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates.\ud Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction. Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies. Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries

Illness Mapping: A time and cost effective method to estimate healthcare data needed to establish community-based health insurance

Background: Most healthcare spending in developing countries is private out-of-pocket. One explanation for low penetration of health insurance is that poorer individuals doubt their ability to enforce insurance contracts. Community-based health insurance schemes (CBHI) are a solution, but launching CBHI requires obtaining accurate local data on morbidity, healthcare utilization and other details to inform package design and pricing. We developed the "Illness Mapping" method (IM) for data collection (faster and cheaper than household surveys). Methods. IM is a modification of two non-interactive consensus group methods (Delphi and Nominal Group Technique) to operate as interactive methods. We elicited estimates from "Experts" in the target community on morbidity and healthcare utilization. Interaction between facilitator and experts became essential to bridge literacy constraints and to reach consensus.The study was conducted in Gaya District, Bihar (India) during April-June 2010. The intervention included the IM and a household survey (HHS). IM included 18 women's and 17 men's groups. The HHS was conducted in 50 villages with1,000 randomly selected households (6,656 individuals). Results: We found good agreement between the two methods on overall prevalence of illness (IM: 25.9% ±3.6; HHS: 31.4%) and on prevalence of acute (IM: 76.9%; HHS: 69.2%) and chronic illnesses (IM: 20.1%; HHS: 16.6%). We also found good agreement on incidence of deliveries (IM: 3.9% ±0.4; HHS: 3.9%), and on hospital deliveries (IM: 61.0%. ± 5.4; HHS: 51.4%). For hospitalizations, we obtained a lower estimate from the IM (1.1%) than from the HHS (2.6%). The IM required less time and less person-power than a household survey, which translate into reduced costs. Conclusions: We have shown that our Illness Mapping method can be carried out at lower financial and human cost for sourcing essential local data, at acceptably accurate levels. In view of the good fit of results obtained, we assume that the method could work elsewhere as well

An evaluation of the factors that affect the health-related quality of life of children following myelosuppressive chemotherapy

PurposeThe purposes of this study, in children who were assessed 1 week after the administration of myelosuppressive chemotherapy were: to compare the total and subscale scores on a generic measure of health-related quality of life (HRQOL) to normative data from healthy children and describe the relationships between demographic, clinical, and symptom characteristics of children with cancer and generic and disease-specific dimensions of HRQOL.MethodsPatients (n = 61) were predominantly male (52.5%), minority (63.9%), and 14.7 years of age. Children completed the Memorial Symptom Assessment Scale for 10- to 18-year olds, the PedsQL™ Generic and Cancer Modules, and the Karnofsky Performance Status (KPS) scale 1 week after the start of a chemotherapy cycle.ResultsThe mean number of symptoms per patient was 10.6. Compared with the normative sample, children with cancer reported significantly lower scores for the total scale and all of the subscales except emotional and social functioning. No significant differences were found between any demographic characteristics and total or subscale scores on the generic or disease-specific measures of HRQOL. Lower KPS scores were associated with poorer generic and disease-specific HRQOL scores. In addition, a higher number of symptoms was associated with poorer generic and disease-specific HRQOL scores. Finally, higher symptom distress scores were associated with poorer generic and disease-specific HRQOL scores.ConclusionAmong the demographic, clinical, and symptom characteristics studied, poorer functional status and higher symptom burden were associated with significant decreases in HRQOL in children who received myelosuppressive chemotherapy

Ionospheric modelling using GPS to calibrate the MWA. 1 : Comparison of first order ionospheric effects between GPS models and MWA observations

This document is the Accepted Manuscript version of the following article: B. S. Arora, et al, ‘Ionospheric Modelling using GPS to Calibrate the MWA. I: Comparison of First Order Ionospheric Effects between GPS Models and MWA Observations’, Publications of the Astronomical Society of Australia, Vol. 32, e029, August 2015. The final, published version is available online at doi: https://doi.org/10.1017/pasa.2015.29. COPYRIGHT: © Astronomical Society of Australia 2015.We compare first order (refractive) ionospheric effects seen by the Murchison Widefield Array (MWA) with the ionosphere as inferred from Global Positioning System (GPS) data. The first order ionosphere manifests itself as a bulk position shift of the observed sources across an MWA field of view. These effects can be computed from global ionosphere maps provided by GPS analysis centres, namely the Center for Orbit Determination in Europe (CODE), using data from globally distributed GPS receivers. However, for the more accurate local ionosphere estimates required for precision radio astronomy applications, data from local GPS networks needs to be incorporated into ionospheric modelling. For GPS observations, the ionospheric parameters are biased by GPS receiver instrument delays, among other effects, also known as receiver Differential Code Biases (DCBs). The receiver DCBs need to be estimated for any non-CODE GPS station used for ionosphere modelling, a requirement for establishing dense GPS networks in arbitrary locations in the vicinity of the MWA. In this work, single GPS station-based ionospheric modelling is performed at a time resolution of 10 minutes. Also the receiver DCBs are estimated for selected Geoscience Australia (GA) GPS receivers, located at Murchison Radio Observatory (MRO1), Yarragadee (YAR3), Mount Magnet (MTMA) and Wiluna (WILU). The ionospheric gradients estimated from GPS are compared with the ionospheric gradients inferred from radio source position shifts observed with the MWA. The ionospheric gradients at all the GPS stations show a correlation with the gradients observed with the MWA. The ionosphere estimates obtained using GPS measurements show promise in terms of providing calibration information for the MWA.Peer reviewe

Measuring (KSK +/-)-K-0 interactions using pp collisions at root s=7 TeV

We present the first measurements of femtoscopic correlations between the K-S(0) and K-+/- particles in pp collisions at root s = 7 TeV measured by the ALICE experiment. The observed femtoscopic correlations are consistent with final-state interactions proceeding solely via the a(0)(980) resonance. The extracted kaon source radius and correlation strength parameters for (KSK-)-K-0 are found to be equal within the experimental uncertainties to those for (KSK+)-K-0. Results of the present study are compared with those from identical-kaon femtoscopic studies also performed with pp collisions at root s = 7 TeV by ALICE and with a (KSK +/-)-K-0 measurement in Pb-Pb collisions at root s(NN) = 2.76 TeV. Combined with the Pb-Pb results, our pp analysis is found to be compatible with the interpretation of the a (980) having a tetraquark structure instead of that of a diquark. (C) 2018 Published by Elsevier B.V.Peer reviewe

Spin alignment measurements using vector mesons with ALICE detector at the LHC

We present new measurements related to spin alignment of K*(0) vector mesons at mid-rapidity for Pb-Pb collisions at root s(NN) = 2.76 and 5.02 TeV. The spin alignment measurements are carried out with respect to production plane and 2nd order event plane. At low p(T) the spin density matrix element rho(00) for K*(0) is found to have values slightly below 1/3, while it is consistent with 1/3, i.e. no spin alignment, at high p(T). Similar values of rho(00) are observed with respect to both production plane and event plane. Within statistical and systematic uncertainties, rho(00) values are also found to be independent of root s(NN). rho(00) also shows centrality dependence with maximum deviation from 1/3 for mid-central collisions with respect to both the kinematic planes. The measurements for K*(0) in pp collisions at root s = 13 TeV and for K-s(0) (a spin 0 hadron) in 20-40\% central Pb-Pb collisions at root s(NN) = 2.76 TeV are consistent with no spin alignment

Muon physics at forward rapidity with the ALICE detector upgrade

ALICE is the experiment specifically designed to study the Quark-Gluon Plasma (QGP) in heavy-ion collisions at the CERN LHC. The ALICE detector will be upgraded during the Long Shutdown 2, planned for 2019-2020, in order to cope with the maximum interaction rate of 50 kHz of Pb-Pb collisions foreseen for Runs 3 and 4. The ambitious programme of high-precision measurements, expected for muon physics after 2020, requires an upgrade of the front-end and readout electronics of the existing Muon Spectrometer. This concerns the Cathode Pad Chambers (CPC) used for tracking and the Resistive Plate Chambers (RPC) used for triggering and for muon identification. The Muon Forward Tracker (MFT), an internal tracker added in front of the front absorber of the existing Muon Spectrometer, is also part of the ALICE detector upgrade programme. It is based on an assembly of circular planes made of Monolithic Active Pixel Sensors (MAPS), covering the pseudorapidity range 2.5 < eta < 3.6. The MFT will improve present measurements and enable new ones. A selection of results from physics performance studies will be presented, together with an overview of the technical aspects of the upgrade project

Direct photon elliptic flow in Pb-Pb collisions at root s(NN)=2.76 TeV

The elliptic flow of inclusive and direct photons was measured at mid-rapidity in two centrality classes 0-20% and 20-40% in Pb-Pb collisions at root s(NN) = 2.76 TeV by ALICE. Photons were detected with the highly segmented electromagnetic calorimeter PHOS and via conversions in the detector material with the e(broken vertical bar)e pairs reconstructed in the central tracking system. The results of the two methods were combined and the direct-photon elliptic flow was extracted in the transverse momentum range 0.9 < p(T) < 6.2 GeV/c. A comparison to RHIC data shows a similar magnitude of the measured direct-photon elliptic flow. Hydrodynamic and transport model calculations are systematically lower than the data, but are found to be compatible. (C) 2018 The Author. Published by Elsevier B.V.Peer reviewe